Hi,

I am newto this site....needed someone who knew how I felt. After months of jumping through hoops, following procedures and paying out of pocket Cigna decided no. Iam depressed and frustrated and feel like I was led astray. It seems that if I were to wait for more complications from my Diabetes or Asthma they will cover these charges without question. Yet proactive.......NO. I guess I will appeal, but really felt like this was my last real hope. Thoughts Anyone? Prayers?:thumbup:

I am so sorry to hear about your insurance being butts:mad:. I self paid so I would'nt have that problem. I would'nt of been able to pay but had my inhearatence. I would definatly appeal their decision. good luck to you. I will be praying for you.

Don't get discouraged! Appeal, get more documentation showing your comorbidities. You will read of many people on this forum that appealled numerous times before their insurance covered the procedure. If you truly want this surgery- buck up and get ready to fight for what you need:thumbup:

I'm sorry you were denied. I've been there ~ Cigna denied me too. It's frustrating and just makes ya crazy :-) But hang in there. Appeal it - keep at it. Kelley Lindstrom from ObesityLaw.com helped me and I was approved. My surgeons office contacted her - they take some cases for no charge. Lucky me I was one of them. I only worked with Kelley and she was great! I've read good things about her husband Walter as well. Good Luck - keep going - let us know your progress.

I know how you feel to some extent as I was denied by my insurance company for a pannicolectomy after losing nearly 300 pounds. I went through a horrible depression for the last couple of weeks but now I'm kicking into fighting mode and planning on giving my insurance company as much grief as possible! I'm going to appeal out the wazoo or until they're so sick of my bugging them they'll approve my procedure. My denial was based on not enough documentation that it was a medical necessity. I don't know what more they need than my cronic rashes, yeast infections and killer back pains. I tell you what, let's both make our minds up to appeal the hell out of our insurance companies decisions and keep each other in our prayers. The lap band has given me my life back and I just hope and pray the same will happen for you. I keep telling myself that I didn't gain all the weight overnight and I didn't lose it overnight either so if I have to wait a while longer for my surgery...so be it. I just know I'm going to make it happen just as you will. One thing I'm going to do is go to my doctor every time I have a rash or infection and have it documented. Maybe the insurance company will get so tired of paying out money that way they'll approve me. I don't know much about the appeal process but I'll sure keep you posted on what I find out. Hang in there and let's both be determined to make this happen. Good luck and my prayers are with you!

Thanks for the prayers and the pep talk. I REALLY appreciate knowing you share my experience. I am getting it together for the appeal process. And I will keep looking and moving forward. thanks for your support.

I was denied twice by Cigna, and they finally approved me on the third try. So don't give up. You should call them and find out why you were denied. That can help you fix what you need when you appeal.

I sent in all info required based on info I received from cigna in January..BUT their requirements for documentation changed as of May 18 2008 requiring MUCH more data comorbitiy length ect...now I have to jump through more hoops before I can appeal.

:thumbup:Cigna will have you standing on your head while eating spaghetti if they thought you'd back down from trying to get this surgery.... I'm on my 2nd appeal with them right now and I refuse to give up.

Hang in there....!!

Kksgranny-- do you know why you were denied? I have CIGNA too and awaiting word. Am concerned as I have heard that CIGNA can be very difficult.

With Cigna, you want to make sure you have a copy of everything that was submitted first of all...

Then, make sure there is CLEAR indication in your paperwork that you have the 2 years of BMI being at or above 40.

You need a medical necessity letter...definitely.

And the last thing that *I* did was I sent a letter directly to the nurse handling my case. In this instance it was Susan Smith out of Pittsburg, PA. I addressed her personally and explained why I wanted and needed the surgery and that I had worked hard at getting all the information she requested and I even went as far as breaking down the timeframe of my BMI. 2006 = 40, 2007 = 45, etc...

The letter was about 1/2 a page but I just quickly outlined how weight had been an issue since I was a teenager, how I wanted to be healthier for me and my family....and so on.

It was 2 days after I confirmed she received my letter that I was approved. Do you have the contact information to get to the people who handle the pre-cerfications? I called them DAILY....once in the morning and once right before I left work. They actually knew me by name before I finally got my answer... The people that answer, (MOST) are very, very, nice and want to help you.

Let me know if you have any more questions... I'm not sure what I can do but I'll help you anyway that I can with questions or what I had to do...just let me know.:tongue2:

Good LUCK!!

Mtanna,

Thanks for the info. I will call Cigna and ask for the name of the person handling my file. I feel like I'm in a "holding pattern" right now. This waiting is very frustrating and causing much anxiety.

mtanna, Have you been approved?? I am just now starting my long journey...I am willing to dot the i's and cross the t's, but could use any advice you may have. My BMI is low but i do have co-mobidities...ie: herniated discs in my lower back, gerd, stress incontinence, joint problems and I am waiting for cholesterol bloodwork (it has been high in the past). I have found Cigna to be helpful in the past, but after reading these posts am really concerned. Thank you in advance for any help you can offer. Kimberly

Hey Kimberly!!

YES I was approved, September 10th at 1:00 pm Central Time I get my surgery. The best advice I can give you is CALL, CALL, CALL!!

If you've taken care of all the requirements, you should be fine. HOWEVER, please don't be discouraged because there is a good chance you'll be denied the first time. You have to be on your game though, don't give up. DO NOT TAKE NO FOR AN ANSWER!!

Do you have a letter from your doctor stating you NEED this surgery? I say that because if you are below the BMI requirement then you need to get a letter to them ASAP. They may not need it but I worked almost everyday getting them every single bit of information I could.

Good luck in your journey and please let me know if there's anything you need from me. I will be happy to help in anyway that I can.

I know the frustration and the pain of being denied. I cried for 2 hours the first time they told me no. My sister let me feel sorry for myself for all of that 2 hours then told me to get off my a$$ and fight for what I wanted and I did....and it worked.

I'm here .....Anyone and everyone is welcome to ask me anything having to do with Cigna!! I feel like I'm an expert at this point:sneaky:

I have been denied by CIGNA again!!!!! It seems they can never "HAVE ALL THE INFO NEEDED" even though it has been sent multi times by multi people. They will not give me a name of the person handling my case. I have had 3 medical necessity letters,fasted for 7months x2 in the last 5 years and have all of my monthly documentsx 8 months. They wont count the dietitian because she did not take vital signs. They say the only process is peer to peer review. I am frustrated but not giving up...but it is wearing on me physically and mentally. My blood sugar is up..Dont know what to do ..I am glad people do get approved it gives me a littlehope!

Mtanna, Thank you so much for the encouraging words...I really needed them. I have 3 docs that are writing me letters (obgyn, podiatrist, PCP) The PCP wrote the letter a month a go and it was wonderful. Now Cigna is requiring 24 months of history, so I have my appt with him tomorrow to see if he will research back 24 months. I have yo yod so much that I am sure there will be a month or two that I was below 35 BMI....not sure. I received a response from someone that went thru everything with Cigna and was denied...she had the same BMI and similar co-mobidities....I know everyone is different...I just pray Cigna sees that this is my only chance of having a long life with my young children.

Congrats on your approval....I am sure all the hard work will be worth it. Sept 10th will be here faster than you can imagine. Have you had all of your pre visits?? Nutritionist, Trainer etc?

Kimberly